ORIGINAL ARTICLE

FACTORS AFFECTING SERUM FERRITIN LEVEL IN

SCHOOL GOING CHILDREN OF DISTRICT BANNU

Muhammad Shoaib Khan1, Shahnaz2, Riffat Sultana3, Irshad Ali4

ABSTRACT
Objective: To investigate the factors affecting serum ferritin level in school going healthy children in Distt
Bannu, Khyber Pakhtunkhwa and to know the potential risk in children associated with hypoferritinemia,
leading to microcytic hypochromic anemia in our population.
Methodology: This cross sectional study was carried out at Institute of Kidney Diseases (IKD) Hayatabad
Medical Complex Peshawar in one year time from March 2010- March 2011. A total of 113 healthy
children of both genders were selected with no history of bleeding, blood transfusion, any extensive
surgery or infections. 05cc blood sample was taken from each child. Out of which, 03cc were used for
ferritin estimation by using the Roche Elecsys 2010 Immunoassay Analyzer, while 02cc were used for basic
hematological examination, using Sysmex k-1000.
Results: There was no significant relationship between serum ferritin of boys and girls (p>0.05).However
boys had high ferritin level as compared to girls. While comparing serum ferritin in rural and urban areas
it has been observed that serum ferritin was high in rural areas. Moreover serum ferritin was positively
correlated with hygienic conditions (p=0.01) and dietary intake (p=0.00).
Conclusion: The finding of our study reveals that serum ferritin level is quite low in female population in
both urban and rural areas, hence anemia and low iron status are more prevalent in female population.
Environmental conditions, socioeconomic factors and diet habits are the main factors, which affect ferritin
level in children.
Key Words: Serum Ferritin, School going children, Microcytic hypochromic anemia
This article may be cited as: Khan MS, Shahnaz, Sultana R, Ali I. Factors affecting Serum Ferritin level in School going
children of District Bannu. J Postgrad Med Inst 2012; 26(3): 237-41.
INTRODUCTION body. In iron deficiency anemia, malabsorbtion or
blood loss during bleeding, infection, injury or
Ferritin is colorless protein and is finely
heavy periods during menstruation in females or in
dispersed in tissues, where it is not ordinary
insufficient diet, the iron ferritin level become
visible microscopically. It is composed of spherical
outer shell of an iron-free protein, apoferritin, and low.2 High concentration of serum ferritin(>1000
ng/ml) may be due to various reasons which are
an inner core of trivalent iron Fe+3 (oxidized)1.
Ferritin shows symptoms of stored iron in the not related to the amount of iron in our body.3,4
Serum ferritin is also associated with behavioral
1,4
Department of Biochemistry, Bannu Medical changes, developmental level in preschool children
College, Bannu - Pakistan (autistic problem). Iron deficiency anemia (IDA)
2
and iron deficiency (ID) was also high reported in
Department of Chemistry, Gomal University, autistic spectrum diseases especially in children5,6.
Dera Ismail Khan - Pakistan Iron deficiency anemia is also related to cognitive
3
Department of Physiology, Khyber Girls diseases of young children. There is an association
Medical College, Peshawar - Pakistan between hemoglobin and cognitive function in
children having iron deficiency anemia but,
Address for Correspondence: however, with normal serum ferritin concentration
Dr. Muhammad Shoaib Khan, it did not change7. It has been found that severe
Associate Professor, anemia mostly affects children during the first year
Department of Biochemistry, of life.
Bannu Medical College, Bannu - Pakistan
E-mail: mshoaibkhan2003@yahoo.com For the diagnosis of iron deficiency
anemia in infants different laboratory tests were
Date Received: June 22, 2011 performed including serum ferritin, mean cell
Date Revised: February 23, 2012 volume and hemoglobin8.
Date Accepted: March 1, 2012
The association between serum ferritin and

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 FACTORS AFFECTING SERUM FERRITIN LEVEL IN SCHOOL GOING CHILDREN OF DISTRICT BANNU
different parameters/variables like Hb, PCV, MCV,
MCH, MCHC, RBC, age, gender, location, diet,
etc has been intensively reported in children in the
past. In many developing countries iron deficiency
anemia is associated with low ferritin
concentration and Serum ferritin less than 12ng/ml
is a powerful indicator in the diagnosis of anemia.
Keeping these in mind, the present study
was designed to investigate the factors affecting
serum ferritin level in school going healthy
children in Distt Bannu, Khyber Pakhtunkhwa and
to know the potential risk in children associated
with hypoferritinemia, leading to microcytic
hypochromic anemia in our population.
METHODOLOGY
I n t h i s C r o s s s e c t i o n a l s t u d y 11 3
apparently healthy children of both genders were
selected with no history of bleeding, blood
transfusion, any extensive surgery or infections
from urban and rural areas of Bannu. These
children were randomly selected from local
community of different areas of District Bannu.
The general physical checkup of all the children
including height and weight were performed. After
that 5cc blood sample was taken from each of the
child.
To obtain serum ferritin estimation, blood
was centrifuged at 3000 revolutions per minute
(rpm) for ten minutes in an electric centrifuge to
obtain serum. The rest of blood sample was
collected in an anticoagulant container for the
determination of hematological parameters and for
morphological studies of RBC's. The blood was
mixed promptly but gently and thoroughly with the
anticoagulant to prevent frothing and damage to
cells. Ethylene diamine tetra acetic acid (EDTA)
was used in the concentration 1.5 mg/ml of blood,
as recommended for routine hematological work.
Serum ferritin levels were determined in
blood samples by using the Roche Elecsys 2010
Table 1: Serum Ferritin, Hb, PCV, MCH and MCHC in Various Age Groups
Age
(years) n Serum Ferritin Hb PCV
5-6 33 41.11±2.16 11.53±1.35 39.99±1.23
7-8 29 48.79± 3.14 11.61± .922 39.74±6.633
9-10 28 51.70± 4.55 11.57±1.09 40.70± 1.33
11-12 23 58.76 ±3.35 12.41± .972 41.48± 4.39
Normal Values: Hb(5-12 yrs): 12-14 gm/dl; PCV:
MCHC: 32-36 g/dl; RBC count: 4.5-5.5 m/cmm Ferritin level: 13-150 ng/ml
JPMI 2012 Vol. 26 No. 03 : 237 - 241
Immunoassay Analyzer. Basic blood studies were
performed by evaluating Hb concentration, PCV,
MCV, MCHC and RBC.Blood samples mixed with
anticoagulant EDTA and investigation was
performed by Sysmex k-1000 auto analyzer. The
work was carried out at Institute of Kidney
Diseases (IKD) Hayatabad Medical Complex
Peshawar.
Operational definitions:
Optimal nutrition: means giving the body
the key nutrients in right amount in right time.
Hygienic Conditions: means proper living
habits, cleanliness & ventilation.
Low & high diet intake: Food low in
calories & RDA, while high diet means food high
in calories & RDA.
Proper & improper sanitation: means
proper disposal of waste & self hygiene, while
improper sanitation is blocked drains, lack of toilet
facilities & water for cleaning.
SPSS computer software version 16 was
used for mean and S.D calculation. Chi square for
qualitative & t test for quantitative analysis were
used for level of significance.
RESULTS
Age wise distribution of children (5-12
years) and serum ferritin and different
hematological parameters like Hb, MCV, PCV,
MCH, MCHC and RBC are presented in Table1. It
can be observed that serum ferritin and other
parameters were high in the age of 11-12 years
while low values were recorded at the of age of 5-
6 years.
Ta b l e 2 r e p r e s e n t s a g e n d e r w i s e
distribution of children including (5-12 years) of
both male and female sexes belonging from both
rural and urban regions. It shows that boys have
high ferritin level as compared to girls. t test was
MCV MCH MCHC RBC
45.69.±.3.46 25.1±2.42 29.1±6.25 4.66 ±.44
57.01±5.35 26.2 ±2.06 29.4±2.39 4.68 ±.46
86.1.±6.25 29.6±2.70 29.9±2.49 4.55 ±.28
88.7± 6.31 31.6±2.06 30.6±2.39 4.58 ±.607
39-52 % MCV: 78-97 fl; MCH: 27-32 pg
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 FACTORS AFFECTING SERUM FERRITIN LEVEL IN SCHOOL GOING CHILDREN OF DISTRICT BANNU

Table 2: Gender- wise Distribution of Healthy Population in Bannu Region

Urban population (n =33) Rural population (n=80) Statistics
Ferritin Ferritin
S. No Gender n %age Gender n %age “t” test
(Mean±SD) (Mean±SD)
1 Boys 14 42.42 38.11±2.16 Boys 52 65 45.11±2.16 p<0.05
2 Girls 19 57.58 29.80±2.34 Girls 28 35 41.11±2.16 p<0.001

Table 3: Distribution of children on Nutritional and Hygienic Basis in Urban,

Rural Region of Bannu
Nutritional Basis Hygienic Basis
Low Normal/High Chi- Proper Improper Chi-
n Dietary n Dietary square n sanitation n sanitation square
Intake (%) Intake (%) test (%) (%) test
Urban
11 33.33 22 66.66 22 66.66 11 33.33
Region
.000 .001
Rural
54 67.50 26 32.5 5 6.25 75 93.75
Region

Table 4: Distribution of Children on the Basis of Socioeconomic Factors

Father income Mother education
Serum Serum Serum ferritin Serum Serum Serum
n ferritin n ferritin n (income> n ferritin n ferritin n ferritin
(income up (income 20000) (Primary) (secondary) (tertiary)
to 5000) 5000-20000)
25 44.88±3.48 66 48.52±3.01 22 51.89±3.41 86 35.55±3.0 17 40.88±3.4 10 42.10±2.3

applied on it and shows significant relation ship DISCUSSION

between them (p>0.05).
Nutritional and hygienic conditions in
urban and rural areas and their effect on serum
ferritin are shown in Table 3. There was a positive
relation between serum ferritin and diet (p=.001).
It has been concluded that children in rural region
have normal dietary intake as compared to urban
region. However there was also a positive
correlation between environmental conditions like
hygienic factors including proper sanitation and
improper sanitation and ferritin values (p=0.00).So
these two factors also affect the ferritin level in
children. Socioeconomic factors like father income
and mother education is also an important factor
effecting ferritin concentration. Table 4 represents
distribution of children on the basis of father
income and mother education and their serum
ferritin value.
In this study serum ferritin concentration
were determined separately for boys and girls in
both urban and rural regions.Statistical data shows
that there is no significant relation between
them.Although according to some reporters serum
ferritin is sex dependent and boys have higher
serum ferritin concentration as compared to girls.
The same has been supported by other
investigators, in both urban and rural regions,
females were more attributed to anemia. 9 In
children, severe anemia can impair growth and
mental development. Children with severe iron-
deficiency anemia may also have an increased risk
for stroke. The low Hb and MCV are associated
with low serum ferritin concentration in anemic
children10. In the population survey it has been
reported that children and women of childbearing
age are more affected. It was found that iron

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 FACTORS AFFECTING SERUM FERRITIN LEVEL IN SCHOOL GOING CHILDREN OF DISTRICT BANNU
deficiency anemia may vary from 17% to 70% in
pre-school children, while in adolescents it may
vary between 14% to 42% and in child bearing age
from 11% to 40% 11. The prevalence of iron
deficiency anemia in children occurs due to low
serum ferritn and low blood hematological
parameters, the same has been shown in the
present study.
The normal range of serum ferritin is
dependent on several variables including
methodology, age and sex.Serum ferritin is also
dependent of hemoglobin, serum iron, and
transferrin12. In the developed world iron
deficiency is mainly a single nutritional problem.
However balanced diet and hygenic condition also
effect serum ferritin concentration and causing iron
deficiency and other disesases.In this study it has
been shown that children likes junk foods had low
serum ferritin ,Hb and other parametrs. Iron
deficiency is an important determinant of anemia
and significant positive correlation has been
reported between the levels of Hb and serum
ferritin13.
Iron deficiency caused by diet is un-
common in healthy adults in countries where meat
is an important part of the diet14. Our study also
showed that economic status and parents education
also effecting serum ferritin and it has been
reported in our study, that the children with low
diet have low concentration of serum ferritin in
both urban and rural areas. Children in lower-
income homes are at higher risk than those in
higher income homes. Whatever the underlying
cause may be, poor socio-economic conditions,
lack of health education and inadequate health
facilities in rural areas of the developing countries
are important contributors. Lower iron status of
our population is due to environmental, socio-
economic and dietary factors. Socioeconomic
factors like father income, literacy and numbers of
family members are the common factors of causing
iron deficiency anemia. It has been examined that
folic acid and vitamin B12 deficiency also affect
total iron intake and anemic status.15 High fetal
mortality is common in anemic pregnant females16.
So babies after birth have low weight, low
hemoglobin and stored iron levels as compared to
non anemic women in gestational stages 17 . So
socioeconomic status and mother education plays a
very important role.
CONCLUSION
The finding of our study reveals that
serum ferritin level is quite low in female
population in both urban and rural areas, hence
anemia and low iron status are more prevalent in
female population. Environmental conditions,
JPMI 2012 Vol. 26 No. 03 : 237 - 241
socioeconomic factors and diet habits are the main
factors, which affect ferritin level in children. so,
it is suggested that iron supplementation program
should be introduced for such children through
primary health care clinics or by community health
workers.
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CONTRIBUTORS
MSK conceived the idea and planned the study. S, RS &
IA did the data collection and analyzed the study. All the
authors contributed significantly to the research that
resulted in the submitted manuscript.
241